Public consultation on HIV prevention strategy using PrEP launched by HIQA
A HIV prevention strategy using “a highly effective drug “ would ward off around 173 infections over the first five years of the programme, according to the Health Information and Quality Authority.
A pre-exposure prophylaxis (PrEP) programme would cost €1.5m in the first year and €5.4m over five years and Hiqa estimates that a “break even” point would be reached after 14 years – where all programme and medication costs will have been recouped.
The Government will introduce a PrEP programme this year that involves the pre-emptive use of oral antiretroviral therapy by HIV-negative people to prevent infection. It includes regular monitoring and testing as well as advice and counselling on safer sex practices.
Hiqa's health technology assessment of a PrEP programme estimates that 1,705 people would join the programme in year one and that around 70% of the costs would be for the drug. However, it points out that a “significant” investment in sexually transmitted infection services would be required.
According to the draft Hiqa assessment report, the primary barriers to introducing a PrEP programme are staffing and infrastructural issues.
There are 23 public STI clinics in 16 counties in Ireland and staff shortages were cited by 18 in a recent survey.
Provisional figures from the HSE's Health Protection and Surveillance Centre show that 528 people were diagnosed with HIV last year – a rate of 11.1 per 100,000 population and an 8% increase compared to 2017
Of those infected, more than three-quarters (79%) were men and almost a third (32%) of those diagnosed had received a previous HIV diagnosis in another country.
In almost half of cases (48.5%) the probable route of transmission was men who had sex with men with heterosexuals accounting for almost a quarter (23.9%) of cases reported to the HPSC last year.
PrEP consists of a fixed dose combination of oral tenofovir/emtricitabine and has been licenced for use in Ireland since 2016. However, it is not reimbursed by the State and those with a valid prescription must pay for it themselves.
Hiqa's director of health technology assessment and deputy chief executive, Dr Máirín Ryan, said they reviewed the evidence and found the PrEP was safe and highly effective at preventing HIV in people at substantial risk.
However, the effectiveness of PrEP was strongly linked with taking the medicine correctly and PrEP must not be taken by individuals with an unrecognised HIV infection as drug resistance mutations might develop.
“This means that it is important that people taking part in a PrEP programme should receive advice on taking the medication appropriately and undergo frequent HIV testing,” she said.
PrEP is available in at least 49 countries worldwide with 11 providing the drug through national programmes. European countries that already have programmes include Belgium, France, Norway, Portugal and Scotland.
Taoiseach, Leo Varadkar, said they wanted to reduce the number of new HIV diagnoses in Ireland and increasing the availability of PrEP would help to do that.
Health Minister, Simon Harris, said considerable work was already underway in the HSE to prepare for the introduction of a PrEP programme that meets appropriate standards.
Hiqa has invited people in Ireland to comment on the draft report before it is finalised. A final report will be prepared for consideration by the authority's board before advice is provided to the Minister for Health.
